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Tonsils  and  Adenoids 


Treatment  and  Cure 


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Tonsils  and  Adenoids 

Treatment  and  Cure 

From  the  Standpoint  of  the  Physician  and  Laryngologist 
In  Preference  to  that  of  the  Surgeon  and  Laryngectomist 

BY 
RICHARD  B.  FAULKNER.  M.  D.,  (Columbia  University) 


THE    BLANCHARD    COMPANY, 
PITTSBURGH,  PA. 


COPYRIGHT  1915 
BY 

RICHARD  B.  FAULKNER,  M.  D. 


THE    BLANCHARD    COMPANY 


CONTENTS. 

Page 

Treatment  and  cure i 

ACUTE  FOSSULITIS  (  ACUTE  TONSILLITIS) 3 

Symptoms  3 

Treatment 4 

Chronic  fossulitis  (Chronic  tonsillitis) 5 

Symptoms  S 

Treatment  6 

Secondary  Diseases  of  the  Tonsils 6 

Symptoms   7 

Treatment 7 

Symptomatic  Diseases  of  the  Tonsils 7 

Reflex  Diseases  OF  THE  tonsils 7 

Symptoms 8 

Treatment     g 

Mechanical  Disorders  of  the  Tonsils 9 

Symptoms 9 

Treatment lo 

enlarged  Tonsils n 

Causes   ii 

Treatment 15 

adenoids 15 

Three  Classes 15 

Treatment 16 

THE  TONGUE  TONSIL 18 

Treatment 18 

The  Tubal  tonsils 19 

Treatment 19 

QUINSY 19 

Symptoms —  20 

Abscesses 21 

Treatment 22 

Cancer  22 

Sarcoma 22 

Fibro-enchondroma 22 

CYSTOMA 22 

Lymphadenoma *2 

PAPILLOMA 22 

Lipoma  2a 

ANGIOMA 22 

Diphtheria 22 

VINCENT'S  Disease  22 

Caution  2j 

prescriptions 26 

Zinc  Versus  Silver  30 


TREATMENT  AND  CURE . 

Under  the  law  of  Hammurabi,  King  of  Babylon,  B.  C. 
2285-2242,  surgeons  who  made  mistakes  had  their  hands 
cut  off.  If  that  were  the  law  now,  many  surgeons  would 
lose  their  hands. 

Cehus,  a  famous  physician,  who  lived  B.  C.  400,  grew  a 
long,  sharp,  finger  nail,  with  which  he  cut  out  tonsils,  as  you 
would  turn  out  an  &gg  from  the  shell.  In  the  course  of  cen- 
turies, the  operation  for  the  removal  of  tonsils  was  revived, 
several  times.    It  is  again  revived,  in  America. 

To  cure  tonsils,  or  adenoids,  it  is  necessary  to  know 
what  they  are,  what  they  do,  and  what  deranges  them.  It 
is  a  question  of  knowledge ;  and  with  this  as  their  guide, 
surgeons  would  save  their  hands,  even  though  the  law  of 
Hammurabi  were  revived. 

There  are  three  sets  of  circulating  channels  in  the 
human  body,  arteries,  veins  and  lymphatics.  Through  the 
latter  flozvs  a  fluid,  called  lymph,  which  protects  the  system 
from  germs  and  other  harmful  matter.  The  lymph  fluid 
contains  a  vast  number  of  lymph  cells,  the  duty  of  which  is 
to  attack  and  destroy  germs  and  other  poisons.  Attached 
to  the  lymphatic  canals  are  countless  numbers  of  little 
bodies,  called  adenoids  (86*).  These  are  divided,  according 
to  size,  into  three  classes.  The  largest  are  named  tonsils, 
the  medium,  lymph  nodes,  and  the  smallest,  lymph  nodules. 
(87)  They  are  filters.  Germs  and  other  harmful  matter 
w^hich  in  any  way  get  into  the  lymphatic  canals  are  carried 
along  until  an  adenoid  is  reached,  and  here  they  are  depos- 
ited and  destroyed,  while  the  lymph  itself  passes  on.    While 

♦Note.  The  figures  in  the  body  of  the  text  refer  to  pages  in 
my  book,  on  "The  Tonsils  and  the  Voice."  The  reader  is  ad- 
vised, in  every  instance,  to  refer  to  the  page  indicated  and 
read  what  is  there  set  forth. 

1 


thus  engaged  in  filtration,  adenoids  swell.  The  amount  of 
swelling  is  in  direct  proportion  to  the  protective  work  they 
are  doing.  There  is  no  other  reason  for  their  enlarge- 
ment. (88.) 

There  are  six  prominent  tonsils.  In  the  back  of  the 
mouth  there  are  three;  one  on  each  sidewall,  named  the 
faucial,  and  one  on  the  back  of  the  tongue,  named  the 
tongue  tonsil.  Behind  the  nasal  passages  there  are  three; 
one  attached  to  the  roof,  named  the  pharyngeal;  and  one 
surrounding  the  orifice  of  each  Eustachian  tube,  named  the 
tubal.  These  six,  connected  by  lymphatic  canals,  are  known 
as  Waldeyer's  lymphatic  ring.  (9)  Connected  with  this 
ring,  there  is  another,  formed  of  smaller  but  similar  bodies 
{lymph  nodes)  and  yet  beyond  this  secondary  ring,  there 
are  countless  thousands  of  still  smaller  bodies  {lymph 
nodules),  scattered  about  in  and  underneath  the  lining  mem- 
branes of  the  mouth  and  the  parts  behind  the  nasal  pass- 
ages. (9,  87) 

The  faucial  tonsils  are  quite  separate  and  distinct  from 
the  others  that  help  to  make  up  the  Waldeyer  ring.  12) 
They  are  suspended  in  the  center  of  a  framework  of 
active  and  important  muscles.  They  change  in  position  con- 
stantly in  singing,  speaking  and  swallowing.  (15)  They 
change  position  rapidly  and  with  great  facility.  (47)  They 
are  covered  and  protected  by  a  strong,  tough  capsule  into 
which  muscular  fibres  are  inserted.  (13  Each  one 
of  these  tonsils  consists  of  a  small  group  of 
lymph  nodes,  of  an  oblong  shape.  These  are  bound  to- 
gether; and  as  the  tonsil  rests  in  its  natural  position  in  the 
back  of  the  mouth,  its  surface  presents  irregular  depres- 
sions. The  surface  is  covered  over  with  the  mucous  mem- 
brane that  lines  the  mouth.  This  membrane  dips  down 
into,  and  lines  the  depressions,  pits,  or  trenches,  formed  by 
the  binding  together  of  the  nodes.    The  general  appearance 

2 


of  the  tonsillar  surface  is  that  of  several  oblong  knobs,  with 
trenches  between  them.  These  little  trenches  are  now  called 
fossitlae,  by  the  Anatomical  Society.  These  fossulae  are 
not  bent,  but  are  quite  straight  and  simple.  They  do  not 
penetrate  the  tonsil.  They  are  not  "holcG"  in  the  tonsil. 
(37)  The  structure  of  these  tonsils  differs  absolutely  from 
that  of  all  other  tonsils.  Through  their  outer  surface,  they 
absorb  nothing.  (13,  126)  They  have  no  facilities  for  ab- 
sorption through  their  outer  surface.  The  capsule,  also, 
prevents  absorption.  (124)  In  the  interior  of  these  tonsils, 
there  is  a  system  of  closed  lymphatic  canals  (123),  which 
connects  zvith  the  lining  of  the  nose.  There  is  also  a  direct 
communication  between  the  interiors  of  the  two  faucial 
tonsils,  by  lymphatic  canals.  (17) 

The  faucial  tonsils  become  diseased  from  six  sources : 
primary,  by  infection  from  the  mouth ;  secondary,  from  the 
nose;  symptomatic,  from  the  blood;  reflex,  through  the 
nerves ;  mechanical,  by  pressure ;  and  by  nezv  growths. 

ACUTE  FOSSULITIS: 

erroneously  called,  acute  tonsillitis.  This  is  an  inflammation 
of  the  mucous  membrane  that  covers  the  outer  surface  of 
the  tonsil  and  lines  the  fossulae.  (29)  It  is  caused  by  direct 
infection  from  a  filthy  mouth,  filthy  teeth  and  gums,  and 
filthy  nose.  (29)  Filthy  matter  (containing  pus-producing 
germs,  the  yellow  and  white  micrococci,  staphylococci  and 
streptococci)  accumulates  in  the  fossular  trenches. 

The  disease  is  sometimes  associated  with  secondary 
trouble  in  the  interior  of  the  tonsil,  carried  from  the  nose 
by  way  of  the  lymphatic  canals. 

Symptoms.  The  throat  feels  sore  in  swallowing,  dry, 
scratchy,  with  sometimes  slight  swelling  and  pain  below 
the  angle  of  the  jaw.  One  or  several  gray  or  yellow  spots 
appear  on  one  or  both  tonsils;  they  are  the  open  mouths 


of  fossulae,  filled  with  filthy  matter.  The  tonsils  are  slightly 
reddened,  and  sometimes  moderately  swollen. 

In  aggravated  cases,  the  tonsils  are  considerably  en- 
larged, red,  painful,  and  the  entire  back  part  of  the  mouth 
is.  inflamed,  with  painful  swallowing,  and  the  accumulation 
of  filthy,  sticky,  mucus.  There  is  headache,  backache, 
slight  rise  in  temperature,  with  general  weakness.  In 
"brashy"  children,  the  temperature  will  sometimes  run  high 
suddenly,  and  then  drop  down  just  as  quickly.  The  disease 
lasts  three  to  six  days. 

For  details  in  diagnosis  of  primary  afifections.  I  refer 
readers  to  pages  273.  280,  281,  282  and  283,  of  my  work  on 
"The  Tonsils  and  The  Voice." 

Treatment.  The  filthy  fossulae  should  be  thoroughly 
washed  out,  with  a  small  syringe  having  a  long,  curved 
nozzle,  using  the  solution  of  borax  (A*),  followed  by  the 
solution  of  resorcin  (J)  or  of  zinc  (H).  A  wad  of  ab- 
sorbent cotton,  held  in  the  grasp  of  long,  curved  forceps, 
should  be  saturated  with  either  the  resorcin  or  zinc  solution 
applied  and  rubbed  well  into  the  fossulae  and  the  surface 
of  the  tonsil.  The  filthy  matter  is  sometimes  removed  from 
the  fossulae  by  aero-suction  with  an  air  pump,  made  espe- 
cially for  this  purpose.  If  any  fossulae  are  plugged  with 
hardened  matter,  or  contain  pus,  they  should  be  opened, 
cleansed  and  sterilized.  (J)  Rigid  hygiene  of  the  mouth 
and  nasal  passages  should  be  enforced,  (306)  and  the  gums 
and  necks  of  the  teeth  kept  free  from  particles  of  decom- 
posing food.  The  bowels  should  be  regulated  by  dieting, 
and  in  children  by  giving  after  each  meal,  one  teaspoonful 
of  spiced  syrup  of  rhubarb.  The  linings  of  the  fossulae 
and  the  surface  of  the  tonsils  should  then  be  hardened  by 
galvano-cautery. 

*Note.    The  capital  letters  in  brackets  in   the  text   refer  to 
prescriptions  at  the  end  of  this  work. 


In  aggravated  cases  (361),  the  filthy,  slimy  mouth 
should  be  rinsed  or  sprayed  with  a  saturated  solution  of 
bicarbonate  of  soda  (B),  followed  with  the  application  of 
guaiacol  (K),  and  then  with  the  application  of  suprarenal 
extract  (G).  These  measures,  repeated  once  or  twice  daily, 
will  rapidly  abate  the  condition.  If  improvement  is  not 
prompt,  then  assist  with  the  administration  of  iron  (O). 
When  the  bowels  are  constipated,  and  the  tongue  coated,  at 
the  beginning  of  treatment  a  dose  of  solution  of  citrate  of 
magnesia  acts  well,  or  a  dose  of  epsom  salts.  For  severe 
headache,  with  rise  in  temperature,  five  grains  of  acetanilide 
may  be  given  to  an  adult,  once  or  tv/ice  daily,  until  relieved. 
For  children,  a  half  teaspoonful  of  spirit  of  Mindererus,  in 
a  little  water,  every  two  or  three  hours. 

CHRONIC  FOSSULITIS: 

also  erroneously  called  chronic  tonsillitis.  This  condition 
is  noted  by  the  constant  appearance  of  dirty  gray  or  yellow 
plugs  hanging  from  the  mouths  of  one  or  more  fossulae. 
When  they  are  thrown  out,  they  have  both  a  foul  odor  and 
taste.  A  filthy  mouth,  teeth,  nose  and  the  crowding  of  the 
fossulae  with  filthy  matter,  prolongs  the  complaint.  The 
fossulae  should  be  washed  out,  and  sterilized  daily,  or  with 
sufficient  frequency  to  keep  them  al)Solutcly  clean.  The 
mouth  and  nose  must  be  kept  clean  and  constantly  sterilized. 
Good  dentistry  is  of  great  value. 

If  the  mucous  membrane  that  covers  the  surface  of  the 
tonsil  and  which  acts  as  a  lining  for  the  fossulae  becomes 
easily  inflamed,  we  have  no  right  to  say,  as  most  doctors 
do  say,  that  the  tonsil  is  a  menace  to  the  entire  human 
system,  and  that  it  should  be  cut  out.  Even  if  it  were  true 
that  the  tonsil,  on  such  account,  is  a  constant  danger  to  the 
general  health,  we  cannot  conclude  that,  for  such  reason, 

5 


it  should  be  destroyed ;  but  that,  upon  the  contrary,  if  we 
should  know  of  any  human  organ  that  becomes  easily 
affected,  it  should  not  be  destroyed,  but  we  should  try  to 
protect  it  as  much  as  possible  against  the  danger  of  infec- 
tion, which,  in  the  case  of  the  tonsil,  is  not  so  difficult  to  do. 
The  mucous  membrane  that  lines  the  fossulae  and  covers 
the  surface  of  the  tonsil  should  be  hardened,  and  thus  made 
more  resistant  to  infectious  germs.  The  application  of 
galvano-cautery  is  the  very  best  remedy  with  which  to 
harden  the  membrane.  The  proper  applications  are  super- 
ficial, painless,  protective  and  preservative.  They  should 
not  be  deep  and  destructive  (362).  By  this  method  of  gal- 
vano-cautery, the  tonsil  is  cured  and  not  destroyed.  (40, 
361,  362).  The  general  system  should  be  hardened  by  regu- 
lated exercise,  good  food,  fresh  air,  etc.  In  all  cases  of 
primary  inflammation  of  the  tonsil,  the  operation  for  re- 
moval cannot  be  too  strongly  condemned. 

SECONDARY  DISEASES 

affect  the  interior  of  the  tonsils,  and  are  caused  by  infectious 
matter  carried  into  them  from  a  filthy  nose,  by  way  of  the 
lymphatic  canals;  (83)  also  from  infections  by  way  of  the 
blood  (37)  ;  and  also  by  infection  from  abscesses  that  occur 
in  the  vicinity  of  the  tonsil.  (83,  284) 

The  researches  of  Menccr  are  here  of  great  value  (33, 
2yy,  282,  283).  They  prove  that  just  in  that  particular  dis- 
ease (articular  rheumatism)  wherein  the  entrance  of  germs 
through  the  tonsil  was  considered  assured,  the  infection 
actually  enters  through  adjoining  tissues,  through  the  count- 
less thousands  of  lymphatic  nodes  and  nodules  of  the  neigh- 
borhood, while  the  tonsils  only  become  diseased  secondarily 
from  the  blood,  or  by  way  of  the  lymphatic  canals  leading 
from  the  nose.    Thus  we  see  that  rheumatism  does  not  enter 

6 


through  the  tonsils.  (22)  Most  infections  in  the  tonsil  are 
secondary,  and  mostly  from  the  nose,  (t,^,  7,y,  38) 

Germs  are  always  present  in  the  nose  in  nasal  catarrh, 
during  attacks  of  cold  in  the  head,  after  nasal  operations, 
and  in  all  babies  and  children  who  constantly  sniffle.  In 
these  cases,  the  tonsils  are  always  infected,  swollen,  painful 
and  tender.  (90)  But  these  tonsils  are  not  inflamed.  Their 
interiors  are  rarely  inflamed;  they  rarely  form  pus.  (143, 
358)  The  swelling,  pain  and  tenderness  indicate  the  salu- 
tary filter  action  of  the  tonsils.  (90)  There  is  always  an 
immediate  improvement  and  prompt  subsidence  of  the  ton- 
sillar condition  after  cleansing  and  sterilizing  the  nasal 
passages.  (307,  308,  309)  Mop  the  nose  at  least  twice 
daily  with  cotton,  saturated  with  solution  (A).  Rinse  the 
mouth  with  the  same  solution,  and  apply  (H)  or  (J)  to 
the  tonsils. 

For  acute  cold  in  the  head,  cleanse  and  sterilize  the  nose 
and  mouth;  apply  ointment  (C)  or  powder  (F),  and  ad- 
minister (N).  Chronic  nasal  catarrh  should  be  treated 
and  cured ;  cleanliness  is  the  first  essential. 

SYMPTOMATIC  DISEASES 

arise  from  infection  of  the  blood,  tuberculosis,  scarlet  fever, 
rheumatism,  etc.  (81)  They  are  called  symptomatic  to  dis- 
tinguish them  from  secondary  affections,  which  latter  may 
be  directly  traced  to  another  locality. 

The  treatment  of  the  tonsil  involves  that  of  the  general 
complaint,  with  enforcement  of  cleanliness  in  the  nose 
and  mouth  and  the  application  of  antiseptics  to  the  tonsil 
(A.  H.  J.). 

REFLEX  DISEASES 

are  so  frequent,  so  important  and  so  little  understood  by 
physicians,  that  it  is  deemed  best  to  refer  all   readers  to 

7 


pag2  286  of  my  book   for  more  detailed   information.     It 
is  not  uncommon  for  the  tonsils  to  become  painful  or  swol- 
len and  painful,  without  apparent  cause.     Pain  anywhere, 
not  associated  with  increased  temperature,  must  be  looked 
upon  as  reflex.  (290)     It  is  common  experience  to  see  the 
face  swelled,  the  jaw  set,  the  muscles  of  the  pharynx  con- 
tracted,  the   masseter   muscle   pressing   firmly   against   and 
causing  pain  in  the  tonsil,  with  an  inability  to  open  widely 
the  mouth,  and  all  as  a  reflex  from  an  aching  tooth.  (290) 
I  have  seen  streams  of  pus  pouring  from  the  mouths 
of  the  fossulae,  associated  as  a  reflex,  in  cases  of  erupting 
molar  teeth.     In  one  case  which  I  saw,  very  recently,  of  a 
lady,  aged  twenty  years,  the  left  tonsil  was  greatly  swollen, 
the  pain  in  it  was  excruciating,  and  streams  of  creamy  pus 
were  pouring  from  the  fossulae ;  and  at  the  same  time,  she 
developed  many  most  excruciatingly  painful  areas  of  reflex. 
These  areas   were   behind   the   left   ear,   over   the   sterno- 
cleido-mastoid  muscle  in  the  neck,  over  the  middle  of  the 
left  collar  bone,  over  the  rib  region  of  the  back,  over  the 
pit  of  the  stomach,  and  in  the  lower  bowel.     The  muscles 
were  contracted  and  stood  out  like  whip-cords  in  the  neck, 
over  the  collar  bone,  and  as  large  as  the  index  finger  over 
the  stomach.    Finger  pressure  over  any  one  of  these  painful 
areas  brought  tears  and  symptoms  of  fainting,  with  a  most 
vigorous  protest.     She  was  on  the  verge  of  collapse.     In  a 
few  hours,  she  cut  a  wisdom  tooth,  ivhereupon  the  tonsillay 
trouble,  with  all  of  the  xvonderful  associated  reflexes,  imme- 
diately disappeared.     The  treatment  consisted  in  the  appli- 
cation of  campho-phenique  to  the  swollen  gum,  which  gave 
comfort  by  relieving  the  pressure  of  the  tooth  against  the 
gum.     This  was  followed  by  the  application  of  tincture  of 
lodme.     I  have  seen  other  similar,  but  less  severe,  cases. 

There  are  four  periods  in  the  development  of  the  teeth, 
when    the    tonsils    become    slightly    enlarged,    painful    and 

8 


tender,  without  inflammation,  or  evidence  of  suppuration. 
These  four  periods  correspond  to  the  times  when  four 
groups  of  molar  teeth  are  in  process  of  cutting  through. 
These  periods  are,  with  little  variation,  at  two  years,  six, 
twelve  and  seventeen.  The  enlargement  of  the  tonsils  coin- 
cides definitely  with  these  four  periods,  (no)  In  these 
cases,  there  is  no  infection  of  either  the  interior,  or  the 
outer  surface  of  the  tonsils.  They  are  nerve  reflexes.  After 
cutting  the  teeth,  the  tonsils  immediately  return  to  their 
normal  condition.  Treatment  with  borax  solution  (A), 
resorcin  (J)  and  campho-phenique  is  sufficient. 

After  operation  for  the  removal  of  tonsils,  contractions 
of  the  wounds  take  place,  and  extensive  adhesions  form, 
leading  to  distortion  of  the  parts,  and  over-stretching  of 
the  muscles  and  mucous  membranes,  causing  endless  reflex 
disorders.  (292)  For  most  of  these  contractions,  distor- 
tions and  reflexes,  there  is  no  relief.  Stomach  and  bowel 
trouble,  constipation,  and  intestinal  worms,  cause  many 
reflex  disturbances  of  the  tonsil.  In  all  cases  of  reflex 
disease  of  the  tonsil,  the  source  of  the  reflex  should  be 
sought  for  and  removed.  Of  course,  in  these  cases,  it  would 
be  an  unpardonable  surgical  blunder  to  remove  the  tonsil. 

MECHANICAL  DISORDERS 

arise  from  mis-use  of  the  voice,  pressure  from  the  cutting 
of  wisdom  teeth,  and  pressure  from  the  abscesses  that  form 
in  quinsy.  Many  voice  users  present  the  following  symp- 
toms :  catarrh  of  the  pharynx  and  larynx,  with  congested 
mucous  membranes ;  arches  of  the  palate  swollen ;  epiglottis 
swollen  and  red ;  vocal  cords  thickened  and  red ;  lining  of  the 
trachea  congested ;  ulcerations  occur ;  congestion  in  the 
trachea  extends  upward  into  the  nasal  passages,  involving 
the  Eustachian  tubes  and  the  middle  ear  in  a  general  sub- 
acute inflammation ;  huskiness  of  the  voice ;  paralysis  of  the 

9 


muscles  of  the  larynx,  and  of  the  vocal  cords;  formation 
of  singer's  nodes.  The  real  cause  of  the  above  conditions 
consists,  not  in  a  long  continued  use  of  the  vocal  organs, 
but  in  a  faulty  luay  of  using  them.  The  trouble  is  purely 
functional. 

In  my  work,  pages  46  to  67,  I  have  explained  at  length 
the  importance  of  the  mechanical,  acoustic  and  phonetic 
functions  of  the  to)isil.  These  functions,  with  their  derange- 
ments, have  never  before  even  been  mentioned  in  the  whole 
range  of  medical  literature.  The  science  of  voice  mechan- 
ism, and  the  phenomena  of  speech  and  song,  do  not  belong 
to  the  physician's  art.  But  the  voice  profession  points  with 
pride  and  justice  to  the  scientific  contributions  of  its  masters 
upon  this  subject.  Garcia  laid  the  foundation  of  scientific 
laryngology.  (184,  185,  186)  And  to  the  masters  in  his 
profession  we  may  wisely  continue  to  appeal  for  instruction. 

Mechanical  afifections  of  the  tonsil,  associated  wdth  the 
mis-use  of  the  voice,  are  beyond  the  realm  of  the  medical 
profession.  Maladies  of  the  timbre,  of  the  middle  register, 
of  solidity,  intensity,  compass,  agility,  tremolo,  the  medium 
out  of  balance,  the  transition  missed,  the  vanished  mezzo- 
tone,  are  difficult  problems.  (299,  317,  319)  These  troubles 
are  not  noted  or  described  in  medical  books.  Their  remedy 
requires  the  application  of  a  correct  method  of  voice  pro- 
duction. They  tax  to  the  limit  the  knowledge  and  experi- 
ence of  the  voice  teacher,  for  the  slightest  error  in  treatment 
may  injure  the  voice  permanently.  (301) 

The  voice  mechanician  and  the  expert  laryngologist 
may  also  be  called  into  counsel.  But  the  ordinary  throat 
specialist,  and  the  laryngectomist — ever  ready  wath  his 
knife — never.  To  all  whose  voices  are  affected,  I  urge  the 
study  of  the  chapters  in  my  work,  on  pages  181  to  240,  the 
Si.Y  Voice  Questions,  241  to  271,  and  the  Hygiene  of  the 
Tonsils  and  of  The  Voice,  306  to  327. 

10 


Voice  users'  tonsils  require  more  consideration  and  less 
treatment  than  those  of  other  persons.  There  are  no  times 
at  which  a  voice  user's  throat  requires  surgical  treatment, 
with  any  assurance  of  improving  the  voice.  Large  tonsils 
in  elder  professional  singers  should  never  be  removed.  (368) 
Many  voices  are  ruined  by  ignorant  throat  specialists. 

Tonsils  are  sometimes  swollen  and  painful  from  direct 
pressure  caused  by  the  cutting  of  a  wisdom  tooth.  They  are 
sometimes  swollen  and  painful  and  even  pushed  out  of  their 
natural  position,  by  the  direct  pressure  of  the  abscess  that 
forms  in  quinsy.  Relief  of  pressure  corrects  the  condition ; 
and  in  the  meantime,  apply  (A.  K.  J.)  and  campho-phenique. 

ENLARGED  TONSILS. 

All  medical  authorities  agree  that  tonsils  are  unusually 
large  in  twenty  per  cent,  of  all  persons  between  three  and 
eighteen  years  of  age,  and  that  after  the  latter  age,  they 
naturally  decrease  in  size.  And  the  most  eminent  authorities 
have  also  declared  that  children  with  large  tonsils  are  gen- 
erally very  healthy,  and  that  they  are  less  easily  affected  by 
diphtheria  than  children  with  smaller  tonsils.  (33)  What 
is  the  explanation  of  these  facts?  On  pages  86  to  90,  in 
my  book,  I  have  shown  that  tonsils  and  adenoids  are  filters, 
and  that  they  always  swell  when  actively  engaged  in  the 
process  of  filtration.  On  page  44,  I  have  presented  the 
proof  that  the  faucial  tonsils  do  not  absorb  through  their 
surface;  and  on  page  45,  I  have  presented  the  further  proofs 
that  they  are  infected  through  the  blood,  and  that  germs  in 
the  nose  are  carried  to  the  interior  of  these  tonsils  by  zvay 
of  the  lymphatic  canals.  Therefore,  I  oflFer  the  following 
explanation  as  the  proper  cause  of  the  enlargement  of  ton- 
sils, between  three  and  eighteen  years  of  age.  Before  three 
years,  babies  receive  constant  care  from  their  mothers.  They 
are  bathed  regularly,  and  some  eflfort  is  always  made  to 


keep  their  noses  and  mouths  clean.  After  three  years,  the} 
are  able  to  walk  about,  and  they  no  longer  receive  quite 
the  same  care.  As  they  grow  older,  they  run  more  at  largc- 
and  indulge  more  in  play.  They  waste  no  time  on  their 
toilet.  Not  until  about  sixteen  to  eighteen  do  they  begin 
to  feel  more  pride  in  their  personal  appearance,  take  pattern 
of  the  better  groomed,  and  appreciate  the  value  of  a  more 
careful  toilet,  and  of  a  cleaner  nose.  Hence,  from  three 
to  eighteen  years  is  the  most  neglected  period  of  life  in 
regard  to  the  cleanliness  of  the  nose.  During  the  period 
from  three  to  eighteen  years,  the  tonsils  have  more  to  filter 
and  they  enlarge  for  the  purpose  of  performing  that  duty. 
Furthermore,  those  whose  tonsils  are  enlarged  during  the 
period  designated  are  unusually  healthy  and  less  affected  by 
diphtheria,  because  their  tonsils  are  actively  engaged  in 
filtration  and  the  consequent  prevention  of  infection  by 
germs. 

In  natural  breathing,  the  air  goes  in  through  the  nose. 
It  is,  therefore,  a  prime  necessity  to  keep  the  nose  clean. 
A  free  and  open  filthy  nose  is  a  constant  source  of  danger. 
The  air  we  breathe  is  full  of  filth.  It  carries  the  germs  of 
disease  into  all  the  breath  passages.  Thirty  cubic  inches 
are  inhaled  with  every  ordinary  breath;  there  are  eighteen 
breaths  every  minute,  and  1080  every  hour ;  540  cubic  inches 
of  air  are  inhaled  every  minute,  and  32,400  cubic  inches 
every  hour.  (307)  And  all  this  goes,  or  should  go,  in 
through  the  nose.  Wherever  dust  is  raised,  in  the  street, 
m  factories,  in  schools,  in  hospitals,  in  homes,  we  inhale 
with  the  cloud  large  numbers  of  germs.  (308)  When  we 
consider  that  all  of  the  dust,  germs  and  filth  contained  in 
this  large  volume  of  air  are  carried  into  the  air  passages 
and  deposited  upon  the  lining  membranes,  and  that  none 
comes  out,  it  is  not  surprising  that  infections  take  place. 
The  dust  in  the  air  we  breathe  causes  disease  in  all  the 

12 


breath  passages.  Disease  of  the  air  passages  is  chiefly  a 
question  of  dust  (29)  Among  Arctic  explorers,  in  the 
regions  of  snow  and  ice,  and  the  absence  of  dust,  there  is 
no  record  of  disease  in  the  breath  passages,  no  colds,  no 
laryngitis,  no  bronchitis,  no  pneumonia.  Modern  bacteri- 
ology teaches  us  that  wherever  a  specific  germ  is  to  be 
found,  the  disease  belongs  to  that  germ.  No  matter  what 
part  of  the  body  is  affected,  if  the  germ  of  tuberculosis  is 
present,  the  disease  is  always  tuberculosis.  A  knowledge  of 
this  fact  makes  treatment  surer,  prevention  more  certain, 
and  mortality  is  greatly  lessened.  (82)  I  have  shown  that 
the  germ  of  cerebro-spinal  meningitis  enters  the  system 
through  the  nose,  by  way  of  the  pharyngeal  tonsil  (89)  All 
tonsils  absorb  through  their  outer  surface,  excepting  the 
faucial.  Large  tonsils  are  naturally  very  active  tonsils ; 
most  highly  protective.  By  their  enlargement  they  some- 
times cause  embarrassment  to  breathing  and  swallowing, 
but  this  is  no  reason  for  cutting  them  out. 

It  is  exceedingly  rare  that  enlargement  of  the  tonsils 
alone  puts  the  life  of  the  patient  in  such  danger  as  to  call 
for  surgical  removal.  In  those  cases  where  sore  throat  is 
frequent,  the  patient  is  apt  to  bleed  seriously  if  a  cutting 
operation  is  attempted,  and  he  will  become  subject  to  fre- 
quent sore  throat  thereafter.  In  these  latter  cases,  where 
inflammations  before  operation  are  frequent,  it  is  best  not 
to  operate,  but  to  adopt  other  and  safer  methods  of  treat- 
ment. It  is  of  the  most  absolute  importance  to  avoid  cutting 
operations  upon  infected  tonsils.  Here,  galvano-puncture 
gives  good  results;  size  decreases  rapidly;  inflammations 
disappear.  Before  galvano-cautery,  test  the  susceptibility 
of  the  patient.  Some  throats  re-act  greatly  under  the 
slightest  cauterization.  Under  these  conditions,  begin  with 
very  light  points  of  galvano-cautery ;  the  condition  of  the 
next  three  days  will  indicate  the  degree  of  susceptibility. 

13 


During  the  galvano-cautery  treatment,  the  tissues 
should  be  touched,  daily,  or  morning  and  evening,  with  a 
concentrated  solution  of  resorcin  (I)  ;  the  inflammation 
thus  will  disappear  rapidly,  and  the  locality  is  thoroughly 
antisepticised.  During  treatment  with  galvano-cautery  or 
resorcin,  I  always  give,  internally,  syrup  of  iodide  of  iron, 
ten  drops  after  breakfast  and  supper,  in  a  little  water.  The 
tonsil  may  present  numerous  affected  fossulae.  These 
should  be  freely  exposed  and  galvano-cautery  applied;  but, 
if  there  are  contra-indications,  such  as  inflammation,  then 
employ  milder  resorcin  solution  (J).  Each  fossula  should 
be  washed  out,  and  then  swabbed  with  a  wad  of  cotton, 
saturated  with  resorcin  solution. 

Another  successful  method  of  treatmnit  for  infected 
tonsils  is  that  of  systematic  swabbing  twice  a  day  with 
glycerite  of  tannin  (L),  for  eight  or  ten  days;  and,  at  the 
same  time,  maintaining  thorough  sterilization  of  the  nose 
with  borax  solution  (A).  Swabbing  with  tannin  rapidly 
shrinks  the  tonsil,  and  lessens  the  dangers  of  hemorrhage. 
Shrinkage  after  tannin  is  sometimes  so  marked  as  to  render 
any  surgical  operation  unnecessary. 

The  teeth  of  larger  children  should  be  cared  for,  and 
diseased  roots  removed,  to  obtain  a  clean  mouth.  It  is  on 
these  conditions  that  complications  are  avoided. 

If,  at  the  time  of  a  proposed  cutting  operation,  the 
tonsils  are  still  inflamed,  or  the  back  of  the  mouth  red  and 
covered  with  mucus,  postpone  the  operation.  In  operating, 
it  is  always  best  to  leave  the  tonsil  stumps  in  children,  and 
especially  in  those  under  four  years  of  age.  The  deeper 
part  has  not  suffered  as  much  as  the  superficial,  and  being 
liberated  from  adhesion  to  the  pillars,  it  can  easily  regain 
its  normal  texture  by  subsequent  medical  treatment. 

Beyond  the  age  of  seven  or  eight  years,  tonsils  seldom 
14 


embarrass  by  their  size,  but  inflammations  are  frequent. 
Here,  all  operations  for  removal  are  objectionable. 

If  the  tonsil  is  large,  smooth,  without  fossulae,  the  gal- 
vano-cautery  puncture  is  the  remedy  par  excellence;  efficient 
and  rapid.  (350,  358,  359,  361,  362,  363,  364) 

With  a  patient  who  bleeds  easily,  a  cutting  instrument 
should  never  be  employed.  With  a  tuberculous  patient,  we 
should  always  employ  galvano-cautery  and  resorcin;  never 
the  knife. 

When  one  part  of  the  tonsil  is  enlarged,  that  part  alone 
should  be  treated, 

TREATMENT  OF  ADENOIDS. 

Enlargement  of  the  pharyngeal  tonsil  has  received  from 
the  untutored  various  names,  as  "adenoids,"  "adenoid 
growths,"  "adenoid  vegetations,"  etc.  (89) 

Besides  the  pharyngeal  tonsil,  there  are  thousands  of 
nodes  and  nodules  in  its  neighborhood,  that  often  swell  in 
unison  with  this  tonsil.     They  are  all  filters. 

Patients  with  adenoids  are  divided  into  three  classes : 

(95) 

1.  Those  in  whom  the  pharyngeal  tonsil  is  hard  and 
very  greatly  enlarged. 

This  class  forms  hardly  8  per  cent,  of  all  patients.  Re- 
moval has  rendered  and  will  render  great  service.  But 
if  obliged  to  repeat  the  operation  several  times,  it  becomes 
necessary  to  institute  the  resorcin  treatment  (I) ;  it  is  the 
only  way  to  render  adenoids  inactive.  It  removes  all  in- 
flammation. 

2.  In  the  second  class  we  include  the  patients  in 
whom  the  growths  are  soft,  large  and  bleed  readily  tinder 
the  pressure  of  the  finger ;  there  is  an  interruption  in  the 
growth  of  the  child,  a  deafness  more  or  less  persistent,  and 

15 


an  inaptitude  for  work.  These  are  readily  cured  by  medical 
treatJiiciit.  The  number  of  treatments  varies  with  each 
patient. 

3.  The  third  class  comprises  those  who  with  slight 
enlargement  present  in  general  only  these  symptoms,  in- 
terrmittent  deafness,  mouth  partly  open,  snoring  at  night. 
Resorcin  will  cause  all  symptoms  to  disappear. 

Hospital  patients  are  all  comprised  in  the  first  class. 
The  treatment  with  resorcin  is  curative,  medical,  and 
zvithout  danger.  With  this  treatment,  relapses,  ivhich  are 
so  frequent  after  cutting  operations,  do  not  occur.  It  is 
not  a  simple  inflammation  that  is  cured  by  this  treatment; 
if  such  v/ere  the  case,  there  would  be  relapses,  but  these  do 
not  occur. 

After  ten  or  twelve  treatments,  one  made  each  day, 
or  every  alternate  day,  the  enlargements  diminish  greatly 
in  volume  and  the  patient  is  soon  completely  cured. 

After  the  fourth  or  fifth  treatment,  the  appearance  of 
a  mild  sore  throat  is  sometimes  noted,  which  is  transi- 
tory. The  secretions  should  be  removed,  and  we  should 
wait  two  or  three  days  before  resuming  treatment. 

After  this  treatment,  the  patient  is  less  subject  to  at- 
tacks of  sore  throat. 

This  treatment,  exempt  from  all  danger,  renders  great 
service  when  the  physician  does  not  zvish  to  perform  the 
operation,  or  when  the  operation  is  impossible  or  danger- 
ous. The  treatment  is  perfectly  applicable  to  children  of  all 
ages.  There  is  no  pain,  and  the  child  offers  no  resistance; 
inflammation  does  not  follow;  the  patient  can  eat  and  drink 
immediately  after  the  treatment.  No  accidents  nor  unpleas- 
ant incidents  have  ever  happened.  Resorcin  is  antiseptic  and 
without  danger  to  the  general  health. 

The  resorcin  employed  is  the  chemically  pure  crys- 
tals:  the  solution  is  made  with  pure  water;   100  per  cent. 

16 


of  each  by  weight ;  and  another  sokition  of  half  that  strength 
for  infants. 

A  wad  of  absorbent  cotton  is  saturated  with  the  solu- 
tion, then  pressed  against  the  lip  of  the  vial  upon  with- 
drawal, so  that  there  will  be  no  excess  to  flow  over  unde- 
sired  parts.  The  cotton  is  held  firmly  in  the  grasp  of  prop- 
erly curved  forceps,  passed  into  the  mouth  and  behind  the 
palate  and  pressed  firmly  upward  against  the  adenoid  en- 
largement. The  parts  touched  become  immediately  covered 
with  a  white  coating. 

After  the  resorcin  treatment,  the  child's  spirits  im- 
prove, deafness  diminishes,  incontinence  of  urine  disap- 
pears, breathing  is  easier.  The  voice  gains  in  timbre,  and 
it  becomes  often  impossible  to  recognize  in  the  robust,  in- 
telligent and  lively  child,  the  little,  puny,  idle  and  apathetic 
child  of  several  months  before.  It  develops  both  mentally 
and  physically. 

Resorcin  treatment  can  tvell  replace  the  surgical  method 
in  over  ninety-tzvo  per  cent,  of  all  patients.  No  deaths,  no 
hemorrhages,  no  accidents  of  any  kind  are  caused  by  resor- 
cin treatment.  It  is  easily  given  in  the  physician's  office, 
or  at  the  patient's  home. 

The  operation  for  adenoids  should  never  be  undertaken, 
zvithout  serious  consideration.  It  should  never  be  perform- 
ed in  cases  that  cause  no  symptoms;  (92)  never  in  patients 
known  as  bleeders. 

The  results  of  operation  ivill  ahvays  be  disappointing 
in  cases  that  accompany  nasal  catarrh;  with  thickening  of 
the  lining  of  the  nasal  passages;  in  cases  of  narrow  nos- 
trils, and  mis-shaped  nose;  in  cases  of  irregular  teeth;  in 
deformity  of  the  upper  jatv;  in  deformity  of  the  mouth 
and  palate;  in  cases  of  deafness,  unth  inflammation  of  the 
middle  ear  and  with  thickening  and  hardening  of  the  lin- 
ings of  the  ear  passages;  in  affections  of  the  ear  drum;  and 

17 


in  all  children  with  poor  constitutions,  improper  or  insuffi' 
cient  food,  and  had  hygienic  surroundings. 

THE  TONGUE  TONSIL 

is  situated  on  the  back  of  the  tongue.  Its  usual  appear- 
ance is  that  of  a  group  of  scattered  nodes.  It  is  generally 
unobserved  except  with  the  laryngeal  mirror.  The  nodes 
composing  it  are  very  active  absorbents.  It  inflames,  forms 
abscesses,  and  enlarges,  the  same  as  other  tonsils.  It  is 
frequently  troublesome,  but  being  unseen,  its  troubles  are 
blamed  on  the  faucial  tonsil.  When  inflamed,  the  whole 
base  of  the  tongue  sometimes  swells,  pains  and  becomes 
tender  on  pressure,  and  both  swallowing  and  speech  are 
difl^icult.  Breathing  is  sometimes  affected.  Treatment  is 
the  same  as  that  which  I  have  advised  for  the  faucial  ton- 
sil. 

Abscesses  should  be  opened  with  the  galvanic  knife;  it 
has  the  advantages  of  thorough  penetration,  a  free  opening 

and  efficient  drainage,  with  safety. 

Lingual  goitre  is  developed  at  the  expense  of  an  acces- 
sory thyroid  gland,  and  is  usually  accompanied  by  enlarge- 
ment of  the  tongue  tonsil. 

In  a  patient  referred  to  me  for  enlargement  of  this 
tonsil,  it  had  attained  the  size  of  an  ordinary  hen's  tgg.  It 
pressed  upon  the  epiglottis,  and  interfered  with  breathing, 
speech  and  swallowing  of  food.  I  removed  the  growth 
with  the  galvanic  knife  by  cutting  down  through  its  cen- 
ter, dividing  it  into  two  halves,  and  by  then  applying  the 
knife  flat  and  cutting  from  each  side  towards  the  median 
line.     The  result  was  entirely  satisfactory. 

The  tongue  tonsil  is  influenced  by  excesses  in  eating, 
drinking  and  the  mis-use  of  the  voice.  It  frequently  in- 
flames and  swells  and  is  obscurely  troublesome  in  aged  peo- 

18 


pie.  Its  neighborhood  is  a  veritable  trap  for  filth.  It 
sliould  be  cleansed  and  medicated  just  like  the  faucial  tonsil. 

THE  TUBAL  TONSILS 

are  situated  in  the  passages  behind  the  nose,  and  they  sur- 
round the  orifices  of  the  Eustachian  tubes,  which  lead  to  the 
ear.  They  enlarge,  like  other  tonsils.  In  the  neighborhood 
of  these  tonsils  there  are  countless  nodes  and  nodules  that 
readily  swell.  The  mucous  membrane  that  lines  the  post- 
nasal cavity  is  exquisitely  sensitive ;  any  and  all  diseases  that 
obstruct  the  nasal  passages  lead  to  passive,  non-inflamma- 
tory swelling  of  this  membrane,  which,  in  turn,  occludes  or 
partly  closes  the  openings  into  the  Eustachian  tubes.  This 
passive,  non-inflammatory  sivelling  is  the  most  important 
factor  existing  in  the  post-nasal  cavity  that  leads  to  the  pro- 
duction of  ear  troubles,  which  latter  are  commonly  and 
wrongly  ascribed  to  "adenoids."  (92,  93)  Massage  of 
the  tubal  tonsils,  by  means  of  the  finger  inserted  behind 
the  palate,  is  mentioned  only  to  be  condemned.  (94) 

The  treatment  of  the  tubal  tonsils  should  follow,  with 
exceeding  care,  along  the  same  lines  as  already  given  for 
the  faucial  and  pharyngeal. 

QUINSY 

is  an  infection  of  the  nodes  and  nodules  embraced  in  the 
secondary  lymphatic  ring  (connected  with  Waldeyer's  ring) 
(9),  and  of  the  countless  nodes  and  nodules  connected  with 
the  numerous  lymphatic  canals  that  extend  still  beyond  the 

secondary  ring. 

At  this  point,  it  will  be  of  interest  to  recall  the  sus- 
pended position  of  the  faucial  tonsil  between  the  anterior 
and  posterior  arches  of  the  palate.  (0pp.  9).     Above  the 

19 


tonsil  there  is  a  triangular  space,  formed  by  the  divergence 
of  the  arches,  and  behind  the  anterior  arch  there  is  a  de- 
pression known  as  the  supra  tonsillar  fossa.  Below  the  ton- 
sil is  a  deep  pit,  separating  it  from  the  tongue.  Through- 
out all  this  region,  there  is  a  superficial  and  a  deep  set  of 
lymphatic  canals,  nodes  and  nodules.  Connected  with 
these  there  is  another  chain  that  extends  down  the  neck 
and  under  the  sides  of  the  tongue.  These  nodes  and  nodules 
are  energetic  absorbers  of  infectious  matter.  Between  the 
faucial  tonsils  and  the  nodes  and  nodules  that  become  in- 
flamed in  quinsy,  there  is  no  connection  whatever,  excepting 
that  when  the  latter  swell  they  then  press  upon  the  tonsils. 
When  the  nodes  and  nodules  are  inflamed,  ignorant  doctors 
call  the  trouble  tonsillitis.  In  quinsy,  there  is  a  rapid  in- 
fection of  all  those  bodies.  The  infection  is  quickly  follow- 
ed by  inflammation  and  an  abscess  in  the  neighborhood 
of  the  tonsil ;  above,  in  front,  or  below  it.  In  most  cases 
the  abscess  forms  above,  at  the  upper  border  of  the  tonsil, 
and  often  involves  the  soft  palate.  In  rare  instances,  the 
abscess  forms  behind  the  tonsil.  Abscess  of  the  tonsil  it- 
self, is  rare,  but  when  pus  is  found  escaping  from  the  ton- 
sil, it  usually  makes  its  exit  from  a  fossula. 

Quinsy  is  rare  in  infancy,  and  disappears  with  advanc- 
ing age. 

Symptoms.  Preliminary  chill,  febrile  disturbance,  and 
feelings  of  depression.  Pain  in  sv/allowing,  rapidly  in- 
creasing in  severity.  Increased  flow  of  saliva.  Thick, 
pasty  coating  on  the  tongue ;  breath  oflfensive ;  loss  of  appe- 
tite, and  constipation. 

Inspection  shov/s  palatine  arch  on  the  affected  side 
reddened,  swollen,  with  a  deep  flush  upon  the  lateral  half 
of  the  soft  palate.  Bulging  of  the  faucial  lining.  The  ton- 
sil is  pushed  out  of  its  natural  position  between  the  pala- 
tine arches,  by  the  inflamed  and  swollen  condition  of  the 

20 


parts  behind  it.  The  displaced  tonsil  may  almost  block  the 
entrance  to  the  throat.  The  tonsil,  itself,  is  sometimes  red- 
dened, but  seldom  much  swollen,  and  careful  observation 
will  show  that  it  is  not  the  center  of  disturbance. 

The  voice  is  thick  and  indistinct ;  the  glands  in  the 
neck  swollen ;  and  the  neck  is  stiff  and  sore,  while  the 
mouth  can  be  only  partially  opened  on  account  of  pain. 

The  disease  lasts  five  or  ten  days.  When  the  abscess 
forms,  it  is  followed  by  quick  relief.     The  abscess  forms : 

1.  Most  frequently  behind  the  anterior  arch  of  the 
palate,  above  the  tonsil.  It  bulges  at  the  upper  and  inter- 
nal edges  of  th^:  anterior  arch.  The  tonsil  is  pushed  back 
by  the  swelling  betzveen  it  and  the  anterior  arch. 

2.  The  next  most  frequent  seat  of  the  abscess  is  limit- 
ed to  the  back  arch,  which  becomes  rounder  and  smoother, 
pushing  the  tonsil  in  front  of  it.  In  these  cases,  the  anter- 
ior arch  remains  absolutely  healthy,  and  the  tonsil  only 
slightly  congested. 

3.  The  external  peritonsillar  abscess  is  less  common 
than  the  preceding,  and  more  serious.  The  parotid,  sub- 
maxillary, and  occipital  glands  become  rapidly  affected. 
The  tonsil  is  pusJied  into  the  middle  line.  The  glands 
in  the  neck  are  more  swollen  than  in  the  preceding  form. 
Pus  may  escape  through  the  pharyngeal  aponeurosis. 

4.  The  inferior  abscess  is  situated  below  the  tonsil, 
betzveen  it  and  the  tongue  tonsil,  behind  the  anterior  arch 
towards  its  base.  The  tonsil  is  pushed  upzvards  against  the 
anterior  arch.  Pain  in  swallowing  is  early  and  severe. 
The  tongue  becomes  immovable.  Infiltration  takes  place 
in  the  lateral  wall,  even  extending  to  the  epiglottis  and  the 
folds  in  the  larynx.  Pus  gravitates  and  forms,  a  lateral 
pharyngeal  abscess,  of  exceptional  gravity. 

The  abscess  that  forms  in  quinsy  does  not  open  into 
the  tonsil.     Neither  do  abscesses  in  the  tonsil  open   into 

21 


the  maxillo-pharyngeal  space.  The  fibrous  capsule  of  the 
tonsil  prevents  it. 

Treatment.  Clean  the  nose  and  mouth  with  borax  solu- 
tion (A).  Apply  resorcin  (I),  followed  by  guaiacol  (K), 
and  suprarenal  extract  (G).  Give  iron  internally  (O). 
Rinse  away  accumulations  of  sticky  mucus  with  soda 
water  (B).  If  bowels  are  constipated,  begin  treatment 
wth  solution  of  citrate  of  magnesia.  If  necessary  to  re- 
lieve pain,  give  acetanilide,  one  five-grain  tablet,  repeated 
in  one  hour  if  not  relieved.  No  more  than  two  or  three 
tablets  in  one  day,  and  none  at  all  if  the  heart  is  weak. 
When  the  abscess  forms,  open  it  promptly.  After  the  ab- 
scess has  opened,  treat  with  great  care,  to  avoid  adhesions. 

After  cutting  operations  for  the  removal  of  tonsils,  at- 
tacks of  quinsy  are  always  more  frequent.  And  they  are 
often  accompanied  by  more  or  less  permanent  enlargement 
of  the  glands  (nodes  and  nodules)  in  the  neck.  (157,  162) 
When  permanently  enlarged,  the  phosphorated  oil  (P)  has 
produced  the  best  results. 

Carcinoma  (Cancer),  sarcoma,  fibro-enchondroma, 
cystoma,  lymphadenoma,  papiloma,  lipoma  and  angioma  are 
growths  that  usually  require  surgical  attention. 

Diphtheria  requires  anti-toxin. 

Vincent's  disease  I  have  seen  benefitted  by  radium  and 
the  X-Ray. 


22 


CAUTION! 

The  surgeon  obtains  no  authority  from  the  law  to  use 
his  knife.  No  law  conveys  to  one  person  the  right  to  cut 
another.  That's  assault.  Assault  is  punishable.  The  pa- 
tient's permission  is  the  surgeon's  privilege.  The  surgeon's 
honor  is  a  pledge.  The  surgeon  must  be  reasonable;  the 
law  expects  it ;  and  the  patient  should  exact  it. 

The  surgeon's  art  unrecognized  by  law,  his  operation 
undefined,  there  is,  therefore,  no  statutory  requirement,  no 
explanation,  no  guide,  no  legal  check  nor  statutory  limit 
to  a  surgeon's  performance. 

The  law  requires  that  the  surgeon  shall  possess  and  use 
reasonable  skill,  learning  and  care,  and  that  he  shall  advise 
against  injudicious  operations. 

A  leading  throat  specialist  confessed  to  Professor 
John  N.  Mackenzie,  Johns  Hopkins  University,  "That,  al- 
though holding  views  hostile  to  its  performance,  he  was 
forced  to  remove  the  tonsils  from  every  patient,  in  order 
to  satisfy  the  popular  craze  and  to  save  his  practice  from 
destruction."  There  are  many  such  cases.  The  same  un- 
lawful practice  is  in  style  all  over  our  land.  Mackenzie  ex- 
presses "the  hope  that  not  only  the  profession,  hut  that  the 
public  shall  demand  that  this  senseless  slaughter  be  stopped." 

Under  the  fake  theory  that  "tonsils  are  full  of  holes, 
absorb  germs,  poison  the  blood,  and  cause  rheumatism 
and  heart  disease,"  the  public  has  been  scared  into  the  false 
belief  that  tonsils  and  adenoids  have  no  right  to  exist;  and 
that  in  every  instance  they  should  be  removed. 

By  whom  has  the  public  been  scared? 

The  Metropolitan  Life  Insurance  Company,  New  York, 
advises  removal ;  illiterate  doctors  in  the  public  schools 
force  operations  upon  children ;  popular  magazines,  through 

23 


mis-informed  writers,  advocate  removal,  and  so  does  the 
daily  press,  through  ignorant  commentators. 

The  slaughter  is  opposed  at  every  leading  university 
in  the  ivorld,  by  such  distinguished  educational  authorities, 
as  Professors  A.  Jacobi,  Columbia;  Henry  L.  Swain,  Yale; 
John  N.  Mackenzie,  Johns  Hopkins ;  E.  L.  Shurly,  Michi- 
gan ;  Charles  P.  Grayson,  Pennsylvania ;  Price-Brozvn,  To- 
ronto ;  Vo7t  Chiari  and  Von  Schrottcr,  Vienna ;  Marage, 
Castex  and  Lermoyes,  the  Sarbonne,  Paris ;  F.scat,  Ton- 
louse;  Moure,  Bordeaux ;  Frankel,  Von  Levinstein  and 
Richard  Lozuenberg,  Berlin ;  Brieger  and  Gorke,  Breslau ; 
Sir  Felix  Semon  and  Sir  St.  Clair  Thomson,  London ; 
Massei,  Naples ;  Schmiegelozv,  Copenhagen ;  Earth,  Leip- 
sig;  Von  Baggen,  The  Hague.  (379,  380) 

The  public  deserves  and  should  receive  of  our  univer- 
sities and  of  their  experienced  sons,  plain  statements  of 
facts,  to  guide  and  protect  it,  from  an  unskilled  army  of 
operators.  The  public  has  a  right  and  should  demand  to 
be  informed,  as  to  operations  that  are  proper  and  of  the 
many  that  are  not.  It  should  be  plainly  advised  in  favor 
of  treatment  that  is  safe,  sane  and  successful,  and  upon 
the  contrary,  thoroughly  warned  against  operations  that 
kill. 

I  am  pleased  with  the  cordial  reception  of  my  book 
on  "The  Tonsils  and  The  Voice,"  by  expert  laryngologists, 
voice  mechanicians,  voice  trainers  and  voice  users,  through- 
out the  world. 

This    work,    on    "Tonsils    and    Adenoids;    Treatment 
and  Cure,"   is  the   result   of   many  years  of   practical   ex- 
perience in  the  medical  treatment  of  these  organs,  and  from , 
the  standpoint  of  the  physician  and  laryngologist,  in  pref-j 
erence  to  that  of  the  surgeon  and  laryngectomist.    It  is  pub-| 
lished  with  the  object  of  furnishing  to  thoughtful  and  con-i 

24 


servative  physicians  a  medical  treatment  for  affected  ton- 
sils and  adenoids,  which  has  already  secured  positive  results, 
and  which  can  be  depended  upon  to  establish  with  those  who 
adopt  it,  a  reasonable  unity  in  professional  proceeding. 

If  Dante  were  alive,  he  would  undoubtedly  add  a  tenth 
cycle  to  his  Inferno,  deeper  and  hotter  than  the  other  nine, 
to  which  he  would  consign  surgeons  who  are  willing  to 
shed  your  blood  for  the  sake  of  a  fee. 

If  what  I  have  written,  in  my  previous  book  and  in 
this  one,  will  result  in  drawing  the  attention  of  the  medical 
profession  and  the  great  public  to  the  surgical  crimes  that 
are  being  committed,  and  lead  to  the  abandonment  of  these 
evil  practices,  mankind  will  be  benefitted,  my  object  will 
have  been  attained,  and  I  shall  be  highly  gratified. 


25 


PRESCRIPTIONS. 

(A)  ^ 

Powdered  Borax     Grains  68 

Essence  of  Peppermint Minims  20 

Warm  water One  pint 

A  toilet  requisite  for  the  nose  and  mouth.  A  cleanser 
and  sterilizer.  Saturate  a  wad  of  absorbent  cotton  with  the 
solution  and  carefully  mop  out  the  vestibule  of  the  nose, 
morning  and  evening,  or  more  frequently,  when  necessary. 
This  method  of  keeping  the  nose  clean  is  greatly  preferred 
to  that  of  using  atomizers  and  douches,  as  the  latter  serves 
only  to  wash  filthy  matter  farther  in,  and  at  the  same  time 
leads  to  trouble  in  the  ears  and  antrum.  The  solution  is 
also  a  very  efficient  gargle. 

(B)  I^ 

Water Ounces  4 

Bicarbonate  Soda,  enougli  to  saturate. 

Essence  of  Peppermint ni.  5 

Used  as  a  gargle  in  quinsy,  it  dissolves  sticky  mucus, 
and  cleanses  the  throat  of  all  foul  secretions. 

(C)  R 

Eucalyptus  Oil  (Binz)   m.  10 

Menthol  ei"-  » 

Camphor  g''- 4 

Superfine  White  Vaseline oz   i 

Relieves  irritation  and  swelling  of  the  lining  of  the 
nose,  in  children  that  sniffle  and  in  acute  colds.  Apply  a 
small  quantity  inside  of  both  nostrils  morning  and  evening, 

(D)  R 

White  Precipitate g""-  3 

Eucalyptus  Oil  (Binz)   ">•  ^° 

Menthol     g""-  ' 

Lanoline '^'^'^  ^ 

Superfine  White  Vaselin* d"".  7 

Relieves  irritation  of  nasal  linings,  with  discharge  of 
26 


mucus.  Valuable  in  inflammation  and  obstruction  of  the 
nasal  passages  in  babies  and  older  children.  Apply  in  the 
nose  morning  and  evening. 

(E;  R 

Lugol's  Solution  Iodine dr.  i 

Liquid  Alboiene  Benzoinated  oz-  2 

Shrinks  swollen  mucous  membranes.  Induces  absorp- 
tion of  inflammatory  thickening  and  relieves  obstruction 
to  breathing  through  the  nose.  Apply  to  the  swollen  mem- 
brane in  the  nose,  on  a  wad  of  cotton,  for  five  minutes, 
every  day. 

(F)  R 

Dried  Suprarenal  Gland  gr.  5 

Menthol gr- 3 

Camphor   gr.  10 

French  Chalk gr.  3° 

Powdered  Acacia dr.  7 '-^ 

For  acute  cold  in  the  head ;  apply  in  the  nose,  as  a 
snuff,  or  with  the  powder  blov^er,  once  or  twice  daily. 

(G)  ^ 

Drifd  Suprarenal  Gland gr.  10 

Orthoform  ( new) ...    •  ■  gr.  10 

Powdered  sugar dr.  3 

Powdered  Acacia dr.  5 

Stops  pain.  Reduces  swelling.  Apply  to  the  tonsils 
with  the  powder  blower,  after  galvano-cautery  treatment. 
Also  in  cases  of  quinsy,  and  other  painful  affections,  once 
or  twice  daily. 

(H)  R 

Zinc  Iodine   ■   •       gr.  20 

Distilled   water  oz   i 

Astringent.  Induces  absorption  of  inflammatory  pro- 
ducts.    Reduces  thickness  and  heaviness  of  the  linings  of 

27 


the  throat,  rendering  them  lighter  and  more  elastic.  Apply 
to  the  membranes  on  a  cotton  swab,  twice  a  day.  Useful 
in  chronic  inflammation  of  the  throat. 

(1)  R 

Resorcin,  chemicallv  pure, 

Distilled  water,  of  each,  by  weight dr.  2 

Cures  inflamed  fossulae.  Reduces  enlargement  of  ton- 
sils and  adenoids.  Saturate  a  small  wad  of  absorbent  cot- 
ton with  the  solution,  apply  with  suitable  forceps,  and  press 
tirmly  against  the  affected  parts.  Be  careful  to  press  the 
cotton  wad,  in  withdrawing  from  the  vial,  against  its  lip, 
to  prevent  supersaturation,  so  that  there  will  be  no  excess 
on  the  cotton  to  run  over  neighboring  parts.    Apply  daily. 

(J)  R 

Resorcin,  chemically  pure gr.  30  to  60 

Distilled  water dr.  2 

Used  for  the  same  purposes  as  prescription  I,  but  for| 
milder  effect.    This  solution,  applied  on  cotton,  is  a  pleasant 
and  powerful  means  of  stopping  nose-bleed. 

(K)  R 

Guaiacol oz-  2 

Oil  Peppermint oz-  ' 

Olive  Oil  oz   I 

Stops  pain.  Apply  on  a  cotton  swab,  or  with  a  camel's 
hair  brush,  once  or  twice  daily,  in  quinsy,  severe  inflamma- 
tion of  the  throat  and  inflamed  gums.  Follow  by  application 
of  prescription  G. 

(L)  R  I 

Glycerite  of  Tannic  Acid oz    i 

Shrinks  swollen  membranes.     Apply  on  a  cotton  wad,; 
or  with  a  camel's  hair  brush,  twice  daily,  to  the  back  ofj 

23 


the  throat^  and  to  affected  tonsils,  to  reduce  congestion  and 
inflammation,  before  performing  an  operation. 
(M)  R 

Camphor 

Menthol 

Chloral  Hydrate 

Oil  Betula,  of  each dr.  2 

Liniment.    Apply  to  the  outside  of  the  throat.    ReHeves 
|3ain,  inflammation  of  the  larynx,  and  swollen  glands. 

:n)  I^ 

Ammonium  Hypophosphite dr.  i 

Tincture  Hyoscyamus dr.  3 

Syrup  Lactucarium,  enough  to  make   oz.  3 

(Aubergier) 

For  acute  cold  in  the  head  or  throat.  One  teaspoonful, 
n  a  little  water,  every  two  or  three  hours,  for  an  adult. 

O)  R 

Tincture  Iron  Chloride 

Glycerine 

Pure  water,  of  each oz.  3 

In  severe  attacks  of  quinsy,  with  suppuration,  severe 
)haryngitis,  and  badly  inflamed  tonsils,  give  an  adult  one 
easpoonful  in  half  a  wineglassful  of  water,  every  two, 
hree,  or  four  hours. 

Oleum  Phosphoratum m.    /^ 

Syrup  Acacia, 

Mucilage  Acacia,  of  each  oz.  2 

For  chronic  enlargement  of  the  glands  in  the  neck, 
live  to  children,  from  six  to  twelve  years  of  age,  one-half 
o  one  teaspoonful,  in  half  a  wineglassful  of  water,  after 
very  meal. 

29 


ZINC  VERSUS  SILVER. 

Throughout  my  professional  career,  I  have  avoided  the 
us>?   of   nitrate   of   silver   in   the   nose   and   throat.      Silver 
produces  argyria.      It  thickens  the  mucous  membranes   to  ] 
which  it  is  applied ;  makes  them  heavy ;  and  causes  cirrho-  I 
sis  or  hardening  of  the  tissues,  with  chronic  hoarseness,! 
and  eventually  ruins  the  singing  voice.  I 

Zinc  Iodide  I  have  used  almost  daily  for  over  thirt) 
years.  It  is  an  ideal  astringent,  resolvent,  and  antiseptic 
It  induces  absorption  of  inflammatory  deposits;  relieve; 
congestion  and  heaviness  in  the  mucous  membranes.  li 
renders  the  membranes  lighter  and  more  elastic,  permittin| 
more  facile  movement  of  the  faucial,  pharyngeal  and  laryn- 
geal muscles,  and  tends  to  overcome  the  thickness,  heavij 
ness  and  ha/rdness  that  silver  always  produces.  t 


30 


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